So you’ve received a script for “pelvic PT”.
Or maybe your friend told you that pelvic PT worked wonders during postpartum recovery?
Or you’ve been doing a little research and this pelvic PT thing may just be the answer to the problems you’ve been having?
What should you expect on day one?
It’s the initial evaluation, I ask the very first question.
“What do you know about pelvic floor PT?”
Overwhelmingly, “Nothing really” or maybe “kegels”
So here it goes, the step by step break down of an initial evaluation at Hudson Valley Physical Therapy
At Hudson Valley PT, we have one hour initial evaluations and one hour private treatment sessions.
Wear comfortable clothing and arrive 15 minutes early
You’ll check in for your visit and fill out some paperwork as well as questionnaires about your symptoms that can help track your progress.
Your physical therapist will introduce themself and get you from the waiting area.
Your pelvic PT will bring you into their private treatment room. You are always welcome to bring a supportive friend, loved one, or even your new baby into the session.
The session begins
You will begin the session by talking about your needs for pelvic floor physical therapy.
Pelvic floor PTs specialize in treatment of pelvic pain, orthopedic pain, bowel, bladder, and sexual dysfunction.
There are no silly questions or embarrassing points to share. Your discussion with your provider is confidential and judgement free.
Bowel, bladder, and sexual dysfunction are all quality of life issues.
We want you to share as openly as comfortable on day one. We will ask questions, but we want to know what matters to you and how working through the problems you’re having can enhance your life.
After speaking to you and setting some goals for physical therapy, we will take out a pelvic model.
At Hudson Valley PT, we have several models for education that best match your anatomy.
We will go through the pelvic floor model in detail with each step of the pelvic floor exam (I’ve saved this piece for a few sections below….so skip ahead if you want to see what this exam is all about)
Each part of the pelvic floor exam is optional, but gives your therapist more information to create the best treatment plan for YOU.
You give consent for each part of the exam.
Yes, we are pelvic health specialists, but everyone on the Hudson Valley team has extensive orthopedic experience as well…and that’s important.
Your pelvic floor isn’t just floating in space. Issues in your neck or that old ankle sprain can absolutely influence your pelvic floor.
We will look at your posture, see how you move, test your strength, and probably take a look at your abdomen too.
You’re more than just a pelvic floor after all. We want the big picture.
Pelvic Floor Assessment
Part 1: Visual Exam
After the orthopedic exam, your therapist will step out of the room and let you change.
You’ll undress from the waist down and lie on your back. A full sized sheet will be provided to cover your lower body.
Your therapist will knock on the door to see if you’re ready and come in.
Your therapist will have you bend your knees or provide a bolster to support your legs.
They will then lift the bottom of the sheet to look at your pelvic floor muscles.
Your therapist is looking at the quality of the skin or for anything that would warrant a visit to a physician as well as signs of muscle overactivity, underactivity, prolapse, or scars.
Physical therapists are movement experts….we want to see how your pelvic floor moves just like any other muscle in the body.
Your PT will ask you to contract ( aka kegel), relax, and bear down which clues us into mobility, strength, and coordination.
We may have you cough as well, to see if your muscles respond appropriately.
Part II: External muscle assessment
Your pelvic PT will then put on a set of gloves and touch the first layer of pelvic floor muscles.
Your therapist is assessing for tissue quality, pain, and resting tissue tension.
During this time, your PT will look a little bit more closely into any scars and may have you bear down to better visualize a prolapse if that’s your concern.
Part III: Internal muscle assessment
After the external assessment, your physical therapist will put on another set of gloves and put lubricant on a finger of the glove.
You may change position on the table to laying on your belly or lying on your side depending on your comfort level or the type of exam done.
Your pelvic floor physical therapist will insert one lubricated finger either through the vaginal canal or in the anus to feel the deeper layer of pelvic floor muscles through the walls of the vagina or rectum.
The type of exam is dependent on the type of pelvic floor dysfunction you present with and your anatomy of course (we see all genders…not just vulva owners).
One exam allows us to assess the anterior (front) pelvic floor and one gives us a better assessment of the posterior (back) pelvic floor. Therefore, both vaginal and rectal muscle assessment and treatment can help you reach your goals.
When assessing internally, your PT will first feel your muscles looking for overall resting tension, scars, or pain. Very similar to the external exam.
After that, you’ll be asked to contract, relax, and bear down in a variety of ways.
This will give your pelvic floor physical therapist information on your muscle strength, endurance, mobility, and coordination.
Following the exam, your physical therapist will leave the room to allow you to change.
Your PT will return when you’re ready and sit down with you.
They will share the findings of the whole exam and lay out a treatment plan for you including an idea of what to expect for treatment sessions going forward, frequency of visits, and answer any questions you may have.
Your physical therapist will then get you started with a home exercise program so you can work toward your goals from day one.
Our front desk staff will help you schedule your follow up visits. You’ll be officially on your healing journey.
Pelvic floor physical therapy can be a bit mysterious and intimidating. I hope that the information above helps you make the choice or encourage a loved one to seek out help for pelvic floor dysfunction.